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New Britain in the Bismarck Archipelago of Papua New Guinea supports 14 endemic bird species and together with New Ireland, forms an Endemic Bird Area that supports 38 restricted range species. Extensive conversion of lowland forest to oil palm plantations resulted in the loss of over 20% of forest under 100 m altitude between 1989 and 2000. However the rate of loss has subsequently slowed (2.2% loss across all altitudes between 2002 and 2014), and much forest remains at higher altitudes: 72% of New Britain remained forested (including secondary forest) in 2014. Despite the ongoing high threat and rich endemic bird fauna, the state of knowledge of the conservation status of birds in New Britain is very poor. We use an unprecedented dataset based on 415 hours of bird surveys conducted in oil palm plantations, as well as primary and secondary forests at all altitudes, to revise the IUCN status of New Britain’s birds. These data indicate that six species of elevated conservation concern are less dependent on old-growth forest than previously assessed. We recommend reduced population size estimates for one species, New Britain Kingfisher Todiramphus albonotatus. We recommend increased population size estimates for seven species: Pied Cuckoo-dove Reinwardtoena browni, Yellowish Imperial Pigeon Ducula subflavescens, Green-fronted Hanging Parrot Loriculus tener, Blue-eyed Cockatoo Cacatua opthalmica, Violaceous Coucal Centropus violaceous, New Britain Boobook Ninox odiosa and New Britain Thrush Zoothera talaseae. Despite our comprehensive surveys, Slaty-backed Goshawk Accipiter luteoschistaceus, New Britain Sparrowhawk Accipiter brachyurus, New Britain Bronzewing Henicophaps foersteri and Golden Masked-owl Tyto aurantia remain very rarely recorded and require further assessment. With ongoing habitat loss, particularly in lowland areas, New Britain’s birds urgently require more attention.

Daphne du Maurier's Rebecca (1938) radiates contempt for most ‘types’ and for both sexes, but it seems to reserve particularly harsh judgement for women. Like its literary antecedent Jane Eyre, the fairytale heroine triumphs at the expense of every other woman in the novel. These women are at best caricatured and at worst condemned, often aligned with sinister, perverse connotation. From the loathsome vulgarian Mrs Van Hopper to the hideous Mrs Danvers, female presence is regarded in this novel as a threat, a dangerous encounter requiring ruthless counter-tactics and survival strategies. In no character is this dangerous horror surrounding femaleness more acutely realized than in the snake-like, subversive Rebecca, and her danger is echoed in nuanced terms in the voice of the storytelling narrator herself.

The question is, though, why would a female novelist write women in this way? So frequently dismissed as a Gothic ‘romance’, that death knell to literary pretension in women's writing, Rebecca is, as feminist critics have been constantly aware, a rather more complex affair in its occupation of liminal territories relating to psycho-sexual desire and patriarchal relationships, and in its narrative tactics that call into question issues of subjectivity, identity, and readerly tactics. Less emphasized in critical discussion, but no less crucial to this text's meaning, is the comment passed within it on an old order in its death throes. Written in 1938 on the eve of war, but set in 1931, Rebecca is a ‘memory text’ that expresses nostalgia for a world of class privilege, excess, and splendour, but that also celebrates its demise. In this sense, the Manderley estate is a ‘monument’ to a past recalled, but its foundation is insecure and the beautiful façade is fissured by flawed masculinist values, acts of bad faith, and shabby moral corruption. This less discussed current in Rebecca is, this essay argues, fundamentally implicated in the expression of misogynistic animus that chiefly concerns the debate here, since it is central to the ironic conversion of the female body into a site of dis/ease, and into a carrier of ideological meaning, and in coded signification gathering around questions of ‘transgressive’ sexual desire.

Experiments were established in 1982 to study the loss of viability of spotted knapweed seeds (achenes) in soil. Greater than 50 and 25% of buried seeds remained viable but dormant after 5 and 8 yr at two locations, respectively. Decline in seed viability was also measured in two natural seedbanks. Although the soil seed reserve decreased by 95% over a 7-yr period, approximately 400 000 viable seeds per ha remained, indicating that spotted knapweed seeds will last for many years in soil.

A study was made on the absorption and translocation and of the effects of perfluidone [1,1,1-trifluoro-N-[2-methyl-4-(phenylsulfonyl) phenyl] methanesulfonamide] on the morphology and anatomy of cotton (Gossypium hirsutum L.) and yellow nutsedge (Cyperus esculentus L.). Concentrations of 1 μM to 10 μM perfluidone added to the nutrient solutions retarded growth of both species. Necrotic spots appeared on the lamina of cotton leaves which were expanded previous to the treatment. Cotton plants resumed normal growth within 11 days after removal of the herbicide. Yellow nutsedge plants remained stunted 18 days after removal of the herbicide. After 6 days, cotton and yellow nutsedge had absorbed 5.4% and 1.7%, respectively, of the 14C-perfluidone (uniformly labeled in the toluidine ring) added to the nutrient solution. Of the 14C absorbed by the plant, cotton and nutsedge translocated 20% and 30%, respectively, to the shoots. A 10-fold higher concentration of 14C was found at the leaf tips of nutsedge than in the other shoot tissues. In cotton shoots the 14C was distributed evenly. Perfluidone inhibited the mitotic indexes of cotton and nutsedge roots 78% and 100%, respectively, in 5 days.

Internal dormancy (the state of internally arrested growth) in western ironweed (Vernonia baldwini Torr.) buds consisted of a recurring annual cycle of high and low activity with transition periods. Trends in sprouting activity were similar regardless of whether activity was measured by sprouting of buds following removal of stems in the field, or by sprouting of rhizome section buds in moist sand. Bud activity measurement was quantitatively different by the two methods, however, and the apparent period when internal dormancy developed also differed. A number of interdependent factors modified activity. At various points in the cycle, the stem apex inhibited bud growth; the stem alone inhibited bud growth; a transient block due to immaturity occurred in some buds; and two temperature-related blocks occurred. Bud age and location on the rhizome had little effect on activity. During the period of internal dormancy, sprouting of buds apparently stimulated activity of adjacent buds. Temperature greatly affected expression of internal dormancy; prolonged moist cold treatment eliminated it.

We developed a technique for obtaining buds which were alike except for the state of dormancy, and measured aerobic respiration and enzyme activities in internally dormant, and active but non-growing, buds of western ironweed (Vernonia baldwini Torr.). In both types of buds respiratory quotient was centered at about 1.2, and slightly higher in the active buds. Respiration rate paralleled specific malic dehydrogenase activity; both were lower in dormant than in active buds. Specific peroxidase and polyphenol oxidase activities did not differ markedly in dormant and in active buds. Respiration rate and all enzyme specific activities increased markedly when active buds were permitted to grow.

Gender equity is imperative to the attainment of healthy lives and wellbeing of all, and promoting gender equity in leadership in the health sector is an important part of this endeavour. This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. We conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity.

Introduction: Paramedics are often required to manage violent or combative patients. In order to do so safely, chemical sedation may be required. There are a number of pharmacologic agents which may be used. However, there is a paucity of evidence as to the optimal agent. Objective: To provide a descriptive analysis of a single base hospital’s experience with combative patients and to determine the efficacy and any adverse events (AEs) in the prehospital setting, associated with midazolam use in these patients. Methods: A retrospective chart review of ambulance calls from 2 urban centers, from January 2012 to December 2015 was completed. All cases of combative patients were filtered and manually examined. Patients were excluded if they were 17 or younger. A priori data points were abstracted by trained research personnel from the ambulance call record. Results: Of approximately 350,000 calls over the study period, there were 269 patients that were combative. Of these, 186 (69.1%) received midazolam for sedation. Multiple doses were required in 33.3% of patients. Depending on route of administration, the average total dose administered was 6.27 mg (SD 3.98 mg) intramuscular, 10.7 mg (SD 4.00 mg) intranasal and 4.95 mg (SD 3.81 mg) intravenous. Midazolam was documented as effective in treating the combativeness in 133 (71.6%), ineffective in 28 (15.1%), and not documented in 25 (13.4%) calls. AEs post midazolam administration, defined as hypotension, bradypnea, bradycardia, or need for airway intervention, were encountered in 3 (1.61%) calls (respiratory rate of 8, hypotension of 88/59 that responded to intravenous fluid and asymptomatic bradycardia of 59). There was a trend of increasing number of combative patients each year over the study period, with a significant difference in the number of combative calls requiring midazolam administration between 2012 and 2015 (50.0% vs 72.8%, p=0.007). Conclusion: Prehospital use of midazolam for combative patients appears to be safe, with minimal AEs. However, midazolam was ineffective in 15.1% and a third of all patients required multiple doses, prolonging the combative period and compromising paramedic and patient safety. Further research is warranted for this cohort’s emergency department (ED) sedation needs and any associated AEs within 1 hour of ED arrival.

Introduction: Paramedics in our region do not perform 15-lead ECGs. As a result, patients experiencing a Right Ventricular Infarct (RVI) may receive nitroglycerin (NTG). In many cases, paramedics do not administer NTG to those with inferior STEMI out of concern that there may be an associated RVI. The purpose of this study is to determine if there is a difference in prehospital adverse events (AEs) associated with NTG administration in patients with unrecognized RVIs compared to those with an inferior STEMI and no RVI. Methods: Ambulance Call Records (ACR) of patients with prehospital STEMI between Jan 1, 2012 and Dec 31, 2015 were analyzed for the incidence of NTG administration. AEs were defined as HR<60 bpm, systolic BP <100 mmHg or drop of 1/3, GCS decrease of >2, syncope, arrest or death. Hospital records were reviewed to determine patients diagnosed with an inferior STEMI without RVI and those with a concurrent or primary RVI as diagnosed on angiography, ECG or discharge diagnosis. Results: Of the 334 ACRs that were filtered and manually reviewed, 144 were excluded (not STEMI, inter-facility transports, duplicate ACR) resulting in 189 patients that had a prehospital STEMI. The mean (SD) age was 66.9 (13.5) years and 70.6% were male. Of 189 STEMI patients, 82 (42.9%) received NTG. Nineteen (41.3%) of these patients were subsequently diagnosed with RVI and 27 (58.7%) had inferior STEMI without RVI. For patients receiving NTG, AEs occurred in 11 (57.9%) within the RVI group, and 10 (37.0%) within the inferior STEMI group (Δ 20.9%, 95% CI -7.8% to 45.4%, p=0.2). Cardiac arrest or death did not occur in either group. A total of 107 did not receive NTG and of these, 93 (86.9%) did not meet conditions or had contraindications for NTG use (22 RVI, 42 inferior STEMI). Three patients had a cardiac arrest and one died while in EMS care, none of which received NTG or had RVIs. Conclusion: Results of this study suggest no difference in the rate of AEs between patients with inferior STEMI and STEMI with RVI when NTG is administered in the prehospital setting. In our EMS system, the conditions and contraindications of NTG administration may be protective against AEs in RVIs, so the potential benefit of a prehospital 15-lead ECG may be limited.

Introduction: When ventricular fibrillation (VF) cannot be terminated with conventional external defibrillation, it is classified as refractory VF (RVF). There is a paucity of information regarding prehospital or patient factors that may be associated with RVF. The objectives of this study were to determine factors that may be associated with RVF, the initial ED rhythm for patients with prehospital RVF, and the incidence of survival in patients who had RVF and were transported to hospital. Methods: Ambulance Call Records (ACRs) of patients with out of hospital cardiac arrest between Mar. 1 2012 and Apr. 1 2016 were reviewed. Cases of RVF (≥5 consecutive shocks delivered) were determined by manual review of the ACR. ED and hospital records were analyzed to determine outcomes of patients who were in RVF and transported to hospital. Descriptive statistics were calculated and all variables were tested for an association with initial ED rhythm, survival to admission, and survival to discharge. Results: Eighty-five cases of RVF were identified. A history of coronary artery disease (47.10%) and hypertension (50.60%) were the most common comorbidities in patients transported to the ED with RVF. Upon arrival to the ED, 24 (28.2%) remained in RVF, 38 (44.7%) had a non-shockable rhythm, and 23 (27.1%) had return of spontaneous circulation. Thirty-four (40%) survived to admission, while only 18 (21.2%) survived to discharge. Pre-existing comorbidities, time to first shock, time on scene, and transport time were not statistically associated with initial ED rhythm, survival to admission or discharge. Patient age was statistically associated with improved rhythm on ED arrival (p=0.013) and survival to discharge (58.24 yrs vs 67.40 yrs, Δ9.17, 95% CI 1.82 to 16.52, p=0.015). Conclusion: The majority of patients with prehospital RVF have a rhythm deterioration by the time care is transferred to the ED. Of these patients with a rhythm deterioration, few survive to hospital discharge. Younger patients are more likely to remain in RVF and survive to discharge. Further research is required to determine prehospital treatment strategies for RVF, as well as patient populations that may benefit from those treatments.

Introduction: Paramedics are required to manage combative patients. In order to do so safely, chemical sedation may be required. Advanced Care Paramedics in our EMS system utilize midazolam for chemical restraint. Our previous research has shown that midazolam appears to have few prehospital adverse events (AEs) associated with its use. However, it required multiple dosages in 33.3% of patients and was deemed ineffective in 15.1% of patients that received it in the prehospital setting. Objective: To determine Emergency Department (ED) AEs associated with the prehospital use of midazolam in combative patients and determine the efficacy of this agent as a chemical restraint during the first hour of the ED stay. Methods: A retrospective chart review of paramedic calls from 2 urban centers, from January 2012 to December 2015 was completed. All cases of combative patients were examined. Patients were excluded if they were 17 or younger. Ambulance call records were linked to the patient’s ED chart. ED charts were reviewed and a priori endpoints were extracted. Results: Of approximately 350,000 calls, there were 269 patients that were combative. Of these, 186 (69.1%) received midazolam in the prehospital setting. During the first hour of their ED stay, 68 (36.5%) required further sedation, while 118 (63.4%) patients did not. Of the 186 patients who received midazolam in the prehospital setting there was one death and one AE in the ED (defined as hypotension, bradypnea, or need for airway intervention). After further review of the charts, both AEs were deemed likely resulting from underlying pathology and not related to the use of midazolam. The average ED Length of stay (LOS) was 7.6 hours for all patients. A total of 82 (44.1%) were admitted to hospital with a mean in hospital LOS of 13.1 days. Conclusion: Prehospital use of midazolam for combative patients appears to be safe, with no reported delayed AEs. 36.5% of this cohort required further sedation within 1 hour of their ED arrival. This supports previous findings that midazolam was ineffective in 15.1 % of prehospital combative patients. Further study is required to determine midazolam’s efficacy and AE profile compared to other prehospital agents in order to ensure optimal safety of both patients and paramedics.

Individuals with chronic respiratory conditions may be at increased risk for pertussis. We conducted a retrospective administrative claims analysis to examine the incidence and economic burden of diagnosed pertussis among adolescents and adults in the USA with chronic obstructive pulmonary disease (COPD) or asthma. Patients aged ⩾11 years with diagnosed pertussis and pre-existing COPD (n = 343) or asthma (n = 1041) were matched 1:1 to patients with diagnosed pertussis but without COPD or asthma. Differences in all-cause costs (‘excess’ costs) during the 45-day and 3-month and 6-month periods before and after the pertussis index date were calculated; adjusted excess costs were estimated via multivariate regressions. The incidence of diagnosed pertussis was higher among patients with COPD or asthma than among matched patients. Compared with matched patients, patients with pertussis and pre-existing COPD or asthma accrued greater all-cause adjusted costs across study periods ($3694 and $1193 more, respectively, in the 45-day period; $4173 and $1301 more in the 3-month period; and $6154 and $1639 more in the 6-month period; all P < 0·0001). Patients with pre-existing COPD or asthma experience an increased economic burden after diagnosed pertussis and may especially benefit from targeted tetanus, diphtheria, and acellular pertussis vaccination strategies.

We conducted infrared spectroscopic observations of bright stars in the direction of the molecular clouds W33 and GMC G23.3 − 0.3. We compared stellar spectro-photometric distances with parallactic distances to these regions, and we were able to assess the association of the detected massive stars with these molecular complexes. The spatial and temporal distributions of the detected stars enabled us to locate sources of ionizing radiation and to gather precise information on the star formation history of these clouds. The studied clouds present different distributions of massive stars.